Thursday, October 19, 2017

3D Kickstarter Counting Down

FoIB Fat Dragon Games' latest 3D DragonLock Kickstarter is winding down, and if you're even the least bit interested in cutting edge 3D printed game terrain (or think you some day might be), this is a must-have:

"Snap-link dungeon terrain on Kickstarter, don't miss out on FREE stretch rewards, and our GM SCREEN OF DOOM"

Wednesday, October 18, 2017

Cost Sharing Reductions: It's Not Sabotage. It's Not a Bailout: Part 2

In Part 1, we learned the difference between subsidies and the much misunderstood CSR's, and why ending the latter isn't a bailout. Now we learn why it's also not "sabotage:"

It's Not Sabotage

Obviously if the Government won't pay their obligation and an insurer still must offer the better level of benefits they will have to factor these expected claims costs into their standard rates. This will push premiums up substantially. Many studies have been done on the financial impact but for ease of math let's assume it will increase costs to Silver plans by 20%.

Yes, 20% is a lot. But keep in mind rate increases in 2014, 2015, and 2016 all rose by significant amounts too. We didn't hear cries of "sabotage" back then. Instead we heard "this won't impact very many people because subsidies (tax credits) will protect them from the increases." So, how is this different? It's not. In fact, because the increases are on Silver plans it will raise the tax credit amounts and reduce the costs for Bronze, Gold, and Platinum plans to those who qualify for subsidies.

This leaves one income group potentially getting the shaft on Silver plan premiums. Anyone who doesn't qualify for a tax credit/subsidy must pay full price. It's easy to assume that these people will suffer because all the discussion - even in this post - has focused for insurance plans sold ON exchange. It's true that insurers must price the same product equally both on-exchange and off-exchange. But, insurers can also offer plans off-exchange that have slight benefit variations at different prices.

Using my example above, an insurer will offer this plan both on and off exchange. The new plan without CSR funding will cost 20% more. The smart insurer will also create a plan that closely mirrors their original plan with a slight tweak - let's say a $6,200 deductible. Because this plan is only offered off-exchange the insurer doesn't have to include the 20% mark up to fund CSR risk. This solves the problem of the 400% and above person not being able to afford a Silver plan.

So, who does this hurt? Over the next 10 years CSR payments are expected to cost more than $200 billion. It's either going to come from Congress appropriating the funds or through higher premium tax credits given to consumers.

The answer is it hurts everyone. Because those in DC want to focus on political agendas and not the real problem we all suffer. Higher taxes, higher premiums, lesser benefits, market uncertainty. All will continue. Because nobody wants to focus on the 80% side of the equation. That 80% side is the actual costs of care.

Cost Sharing Reductions: It's Not Sabotage. It's Not a Bailout: Part 1

Congress and the media are hyperventilating over the Trump Administration announcement that they will end Cost Sharing Reductions (CSR). The result is news feeds full of over-exaggeration, misrepresentation, blatant lies, and name calling. One side of the political aisle calls it sabotage. The other says it's an insurer bailout. Reality is, it's neither.

Before I explain, let's first start by answering what is the cost sharing reduction (CSR) and how does it work? It's quite simple when it's not used as a political football. But, like everything in our political world, the more the bureauweenie can confuse the consumer, the more reliant the consumer becomes on the bureauweenie.

Obamacare has two methods of "financial assistance" written in to the law to help low income individuals. The first method is premium tax credits to help pay health insurance premiums. Those have been funded and have nothing to do with the second method, CSR's.

Under Obamacare, insurance companies are required to offer people making between 100% and 250% of the Federal Poverty Level Silver level insurance plans that have lower deductibles, copays, coinsurance and out-of-pocket-maximums than the standard Silver level plans. Pricing for these plans to are equal to Silver level plans that don't include the CSR's. In exchange for offering these better benefits to low income individuals, Obamacare made a promise that they would refund insurers for the claims they incur between the better benefit Silver CSR options and the standard Silver plans.

Here's an example: three 42-year old's who live in the same zip code that purchase insurance through the exchange. Each has a different income. The first has an income of $19,500, the second has an income of $30,250 and the third an income of $55,000. The actual monthly cost of the lowest priced Silver plan is $248.57. It includes a deductible of $6,100, an out-of-pocket limit of $7,000 and has an office visit copay at $30.

The first person has an income below 250% of the poverty level and the other two don't. So, under Obamacare the first person is eligible for a premium tax credit (subsidy) AND a Silver plan that has better benefits (CSR). His benefits include a $1,100 deductible, an out-of-pocket limit of $2,000 and an office visit copay of $15.

The second person has an income just above 250% but below 400% of the poverty level. Under Obamacare he is eligible for a premium tax credit (subsidy) but not a Silver plan with CSR. He will pay less than the full premium price but have the standard plan with a $6,100 deductible.

The third person is over 400% of the poverty level. He pays full price for the standard insurance plan.

Now that we understand CSR's let's explain why it's not a bailout or sabotage.

It's Not a Bailout

When insurers price their plans they are based on the standard plan. This is where the $248.57 premium comes from. The insurance company math nerds (actuaries and underwriters) develop rates based off assumed risk. This risk does not include the difference between the standard plan benefits and the better plan benefits available to those between 100% and 250% of FPL. The Federal Government -through Obamacare - agreed to reimburse insurers for these claims that they have not financially accounted for.

The amount the insurer hasn't accounted for is the difference in deductible, copay, coinsurance, and maximum out-of-pocket the consumer is liable for. Let's assume all three guys from above have a claim for $25,000. The lowest income guy is only liable for a maximum of $2,000. The second and third guys would be liable for $7,000. Insurers priced for $7,000 out-of-pocket knowing that Obamacare promised to pay the difference in claims between the standard plan limit and the better benefit limit due to Cost Sharing Reductions. In this scenario the difference in the first guy's liability and the standard liability ($7,000-$2,000) would be submitted by the insurer to the Government for reimbursement. It's also important to note that if the first guy is healthy with no claims the Government doesn't pay the insurance company at all.

As you can see, this isn't a bailout to insurers. It's reimbursement for claims they incur that weren't factored in to insurer pricing. Under Obamacare the law states that CSR's are a financial obligation of the Federal Government to insurers. Failure to pay represents a default of our Government.

We explain how it's not "Sabotage" in Part 2.

Tuesday, October 17, 2017

Canary in the Coal Mine – This Sceptered Isle, Part LXXIX

Unprecedented abuse of power by NHS?  Well of course it’s abuse of power.  But unprecedented?  Not so much.  Remember this? 

Fortunately, the public outcry over that one caused NHS to back down.  Who knows what NHS will do this time?

People who believe these things cannot happen in the US are seriously misinformed. Nearly the same thing happened in my own town.  It happened to neighbors of ours whose daughter was diagnosed with mitochondrial disease.  And then the hospital and bureaucrats in the State of Massachusetts took over and tortured the whole family for years.  

People who say nothing like this happens in a nationalized insurance scheme are living in a dream world. These situations will surely arise in the US even if  - and maybe especially if - we end up with some kind of government single-payer medical welfare scheme.

Mark my words.

Making Strides Against Breast Cancer

Once again, I'm raising money with my team: Love, Hope and Faith. Our walk is just a few days away now, his coming Saturday (October 21st) in Dayton, Ohio.

Will you please help out by making a donation - any amount helps.

Thank you!

More ObamaCare Rate Lies

Remember this?

Well, it appears that someone didn't get the memo.


From the Centenniel State:

"Colorado premiums will rise by 6% on top of existing hikes"

And finally, from the Keystone State:

"Insurance premiums for plans sold on Pennsylvania’s ObamaCare exchange will increase by an average of 30.6 percent for 2018"

It appears that most of these are as a result of President Trump's decision to follow the actual law.

Refreshing, that.

[Hat Tip: FoIB Holly R]

Friday, October 13, 2017

Obamacare - When Facts Don't Matter

Former White House COS and current Mayor of the Windy City has been quoted as saying "Never let a serious crisis go to waste.".

Taking a page from Rahmbo's playbook, the current WH resident is doing just that.

Obamacare is failing. Has been from day one. But the only folks who don't see that happening are folks that are either ignorant, those who believe the 44th president walked on water, or they are covering their ears and refusing to listen to facts.

If you are the Gordon Gekko of health insurance and believe that "Obamacare is good" no need to read further. Go to HuffPo or TMZ and have fun with that.

But the Twitterer in Chief who is not known for holding his tongue (or Twitter fingers) has thrown down the Obamacare gauntlet with this tweet.

The Democrats ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix! - The Real Donald Trump

Never let it be said that the man is indecisive.

He calls a spade a spade.

But some folks can't handle the truth.

What is extremely entertaining (to me at least) is found in the comment section below the Real Donald's tweet.

Anyone with a pre-existing condition is going to see premiums skyrocket from TrumpCare. He isn't working with the facts here. Studies, plz!

Seriously, without name calling or rudeness, here are the facts: the ACA saves lives. You are making it worse for poor people and all of us.

I wonder why Obamacare is imploding! Weird! Not sabotage, right?

Well, you get the idea.

Unless you have been indifferent to facts and truth since this mess called Obamacare came into existence.

Obamacare IS in crisis.

Obamacare HAS BEEN in crisis mode since 2013, a full year before it was completely implemented.

At this point there is no way to fix it. Too late to save it for 2018 and possibly beyond. Act II will most likely be a federally funded expansion of Medicaid for anyone not covered by employer group health insurance.

If there are any carriers offering individual health insurance in 2019 it will be those who are able to offer plans that gut the high cost parts of Obamacare, such as guaranteed issue. Medicaid  would then be not only for those who fall below a designated income level but also function as a high risk pool for those with serious health issues.

Those who want to keep Obamacare have some serious denial issues and should seek counseling while they can.

#Obamacare #TrainWreck #Snowflakes

The First Cut is the Deepest

[Note: This is an insurance-free post]

For as long as I can remember, I've always owned good kitchen knives (Wusthof, Henckels, etc). A short time back, I participated in an Indiegogo campaign for a new brand, Misen (as in mise-en-place). This new venture promised high-quality knives at more affordable prices, and I thought it looked promising.

Well, I've had my chef's knife for some months (perhaps a year?) now, and I must say that it performs very well: nice balance, able to keep an edge, comfortable grip.

What isn't so great is how well it's "aging:"

See those spots? Rust, even though I carefully hand wash and dry it after each use.

So I sent an email about it to the Misen folks (including that picture), and this is their reply:

"Hi Henry,

Thanks for sending through that photo. While not common, small stains like this can occur (even on stainless steel knives) for any number of reasons, and they’re not something to worry about!

In my experience with some other knives I’ve used in the past, a product called Bar Keeper’s Best Friend is really effective at removing minor stains like the ones in the photo. Of course, if the issue does get any more serious, please let us know and we’ll be happy to help!

All the best,

To which I say: Bull Feathers.

As previously noted, I've owned similar knives for many, many years, and have never experienced this, let alone in one that's practically brand new.

So I ask, dear readers, am I justified in my disappointment, or unreasonable?


Thursday, October 12, 2017

A Better Pill ?

As a registered Democrat, I receive several emails a day from DNC telling me what to think and what to support and asking for money.  About a week ago, one of the DNC emails told me this about employer-sponsored medical insurance: 

“Today, the Trump administration announced that they're rolling back a mandate requiring employer-provided health insurance to cover contraception -- a rule that has helped at least 55 million women across the country access care.”

There are many sources (here’s one)  that discuss this rollback; it’s far more complex than DNC suggests. But whether the issue is simple or complex; whether details are offered or suppressed; and whether facts are understood or ignored - I think this issue will remain just as controversial, emotional, and resistant to logical analysis as it was before Obamacare.    

Why is that?  Because insurance for contraception has been politicized.  It's a good example how the expanding role of government in providing medical insurance, politicizes medical coverage decisions.  The experience in many other countries teaches that politicizing medical coverage decisions is usually not a good thing.

Keep in mind DNC raised the question of coverage for women who are employed and have incomes.  The great majority of working women can buy contraception using their own income.  For them, insurance is not necessary to access contraception.  So then why do some advocates insist that coverage is unacceptable if it pays a penny less than 100%?  Is $50 a month unaffordable for most working women?  $25 a month?  And why is my own party telling me that coverage less than 100% will reduce access to care for 55 million working women? 

Also consider that employers do not pay their employees above & beyond their wages to cover food, clothing, or utilities.  Is contraception a higher priority than food, clothing, or utilities?  Is there a persuasive argument that employers are denying their employees access to food, clothing, or utilities? I’ve not seen one. Or that the federal government must step in to mandate such extra payments in the name of employee access to food, clothing, or utilities?   I think not.  And that's why I doubt that “free” contraceptive coverage for working women is necessary.   

My opinion: the fundamental issue here is less about the cost of contraception or the level of insurance coverage for it or even access to care.  Instead, the fundamental question is more about whether the federal government has a duty to mandate 100% coverage of contraception for working women.

My opinion:  coverage of contraception for employees is better left voluntary, purchased by employers who choose to purchase it (e.g., Hobby Lobby) based on their own employees' preferences and needs  And I think regardless of the employer’s choice whether to buy such coverage, it is not unreasonable to ask working women to share some part of the cost.  Maybe even the full cost.

Health Wonk Review: Pink edition

October is Breast Cancer Awareness Month, so please forgive this brief detour:

I'm raising money to fight breast cancer with my team: Love, Hope and Faith. Our walk is on Saturday, October 21st in Dayton, Ohio.

Will you please help out by making a donation - any amount helps.

Thank you!

And now, on with the show:

First up, Bradley Flansbaum isn't bullish on long term care: over 70% of seniors will need it at some time, and they're ill-prepared to pay for it. The good news is that Bradley offers some hopeful ideas about how to resolve that.

Next, Andrew Sprung makes the case that the ACA most closely resembles London after the Blitz, citing the Trump administration's meddling as the culprit, and he's not happy about the current situation, or sanguine about the program's future.

Uber Wonk Roy Poses offers his take on what he calls the Health Care Revolving Door. He's concerned about the seemingly endless stream of folks hopping from private industry into government advisory jobs, and vice versa.

HWR co-founder (and dear friend) Julie Ferguson is our guru of WC (Workers Comp), and offers us an insight into how WC costs and benefits are distributed amongst the 50 states. I know very little about WC, and found her information pretty interesting.

Our good friend (and fellow long-time HWR host) Louise Norris offers something I've never seen before. I'll let her explain:

"This post was written by myself and three colleagues: David Anderson, Charles Gaba, and Andrew Sprung. It's an overview of the different approaches that states and insurers have taken with regards to the CSR funding uncertainty for 2018, and the impact that those various approaches have on consumers and overall plan pricing."

Okay, so very interesting Henry, but what makes this unique?


"We all published it concurrently on our blogs this morning."

Isn't that cool? I don't think I've ever seen a post co-written and then concurrently posted like this before.


Our friend Dr Dana Beezley-Smith has been published once again in The National Psychologist, this time on the subject of price transparency in health care (Spoiler Alert: she's for it).

Our own Mike Feehan has a scary pre-Halloween story to tell, as he warns us that the Health Insurance Fee that was temporarily put back on the shelf for 2017 will loom large next year. Why's that? Well, last year it cost insureds about $13 billion. So do the math.

The next 'Review is in two weeks over at David Williams' establishment.

Wednesday, October 11, 2017

Single Payer Blues

So let's see what our Friends Across the Pond© have been up to. Via our friend Rich W:

"A growing crisis in hospital safety is revealed in official figures showing a doubling in the number of legal warnings issued by NHS watchdogs."


The number of "enforcement actions" (basically citations) has more than doubled in the past year, and it doesn't appear that that rate's slowing down:

"Recent actions include a warning notice to Royal Cornwall Hospitals trust after inspectors found patients dying and left to go blind after long waits for treatment."

But hey, free!

On the other hand, it's not as if our own hands are clean:

"VA conceals shoddy care and health workers' mistakes"


Fortunately for those who served our country, putting their lives on the line for all of us, VA healthcare professionals are top-notch.

Oh, wait:

"Medical experts from the Department of Veterans Affairs blamed one botched surgery after another on a lone podiatrist ... In 88 cases, the VA concluded, Franchini made mistakes that harmed veterans."

Good thing the VA bureauweenies caught him in time, and that he paid a severe penalty.

"They let him quietly resign and move on to private practice, then failed for years to disclose his past ... He now works as a podiatrist in New York City."


Okay, well then, good thing this was just a one-off.


"In other cases, veterans’ hospitals signed secret settlement deals with dozens of doctors, nurses and health care workers that included promises to conceal serious mistakes ."

Words fail.

On the bright side, it's not as if single payer systems promote murdering patients to save precious and scarce health care dollars, right?

Um, you may want to be sitting down for this:

"Now, in Canada, a doctor can not only deny life-saving treatment for a person in their right mind who wants it, but actually have that patient, against the patient’s will and with their full mental faculties, outright executed by lethal injection."

"Free" health care: worth every penny you pay for it.

Tuesday, October 10, 2017


"Majority of Households Paying Obamacare Penalty Are Low and Middle-Income"

Almost 4 out of 5 of those penalized bring in under $50,000 a year.

Please remind me what the first "A" in PPACA stands for?

As we noted yesterday, folks who don't qualify for subsides (because they make just a tad too much, but not enough to get out from underneath this trainwreck) are facing record rate increases, and now those folks who can't even afford to buy insurance are getting hit with penalties for going bare.

Something's got to give.

Methinks Maxine was right all along.

[Hat Tip: AssocAmerPhys&Surg]

Monday, October 09, 2017

ACA #Winning: More Lies

You may have seen #FakeNews items like this floating around the 'net, with glaring, fear-mongering headlines:

"Steep Premiums Challenge People Who Buy Health Insurance Without Subsidies"

Don't be fooled by them, we know the truth:

Friday, October 06, 2017

Borrowing a Ride(r)

This is interesting, from the folks at The Standard insurance company:

"With the Student Loan Rider, if you become totally disabled and can’t work, we’ll reimburse all or a portion of your student loan payments so you don’t fall behind."

Now, we've seen imaginative disability insurance products before:

"But what if, because I’m disabled, I’m not earning any income? Even if I could afford to do so (and how many disabled folks are?), I’m not allowed to contribute to my plan until and unless I’m back to work."

Hence, MassMutual's RetireGuard product, which puts money aside for your retirement for you if you're disabled. This new product from The Standard is actually a rider available to physicians and dentist, rather than a standalone policy.

How does it work?

Well, if you're a doc (or dentist) and your Standard DI plan includes this rider, then they'll "reimburse you for your monthly student loan payments if you suffer a total disability and are unable to work." So it's a paid-as-you-go arrangement.

Interesting, really: just when you thought that there's nothing new under the sun, a carrier will come along and prove you wrong.


Thursday, October 05, 2017

From the annals of the MVNHS©

The Much Vaunted National Health Service© continues its proud tradition:

"Most recently, Professor Ted Baker-- the new chief hospital inspector-- declared it was “not fit for the 21st century.”


Turns out, the bureauweenies who actually run the hot mess seem perfectly okay with "[normalizing] wholly unsatisfactory treatment that endangers patients and guard against unacceptable and unsafe practices."

Examples, please?


- Piling patients into hallways
- lack of proper patient monitoring
- shortage of oxygen and medical supplies
But hey: "Free!"

Wednesday, October 04, 2017

MidWeek LinkFest

Our friend Dr Dana Beezley-Smith has been published once again in The National Psychologist, this time on the subject of price transparency in health care (Spoiler Alert: she's for it):

"We could create cost-unconscious consumers in virtually any industry in the country if we introduced third-party coverage."

Yup - Recommended.

Via FoIB Rich W, a thousand words on the failure of Single Payer:

In email from Anthem, some good news:

"Anthem, Inc., has reached a settlement to resolve the multi-district class action litigation relating to the 2015 cyber attack against the company. The settlement did not include any finding of wrongdoing, and Anthem did not admit any wrongdoing or that any individuals were harmed as a result of the cyber attack."


On the other hand:

"Equifax says 2.5M additional individuals potentially victimized during data breach."


ProTip: LifeLock (with special 10% IB discount)

Finally, remember that explicit "If you like your plan..." promise? Well - and you'll want to sit down for this - that guy lied:

"In the face of significant uncertainty surrounding the future direction of U.S. health care policy, Premier Health Plan will discontinue Premier HealthOne Off-Exchange plans on December 31, 2017. This follows Premier Health Plan's June 2017 announcement regarding the 2018 exit from the On-Exchange marketplace"

#ACAWinning #ACACompetition

Monday, October 02, 2017

And some more anecdata

Another in our (seemingly unending) series.

Amy has had her grandmothered United Healthcare HSA-compliant plan since 2013. It sports a $3,000 annual deductible, after which all covered expenses are paid for at 100%. And since it's a PPO plan, she has coverage both in and out of network.

Her current rate of $252 a month is going up by 5%, to $267 a month.

I've suggested that she kiss UHC on the mouth.


Well, she doesn't qualify for a subsidy, so the least expensive comparable Exchange plan (offered by Anthem, believe it or not) is just shy of $300 a month, but it does have a $6,550 deductible/out-of-pocket. Plus, it's an HMO plan, which means that there is essentially zero out-of-network coverage.

Now, she does have some options: for example, she can increase her deductible to $4,000 and save just shy of $400 a year, which might make some sense. We shall see.

Friday, September 29, 2017

More from the 3000% Rate Decrease Dept

Shot (via co-blogger Bob V):

"[Peach State] insurance officials Wednesday gave approval to premium increases of more than 50 percent for the four insurers participating in next year’s insurance exchange in Georgia."

That's actually higher than their original rate hike request.


"In 47 of 50 cities, ObamaCare coverage will be 'unaffordable' in 2018 by law's definition"

Not exactly #BreakingNews, of course, but here's why this is important: folks that are affected by this become exempt from the ObamaTax penalty fee fine tax. Of course, we've never been told how many folks have actually ponied up their ObamaTax obligation.

Wonder why....

Wednesday, September 27, 2017

Wednesday Linkapalooza: FoIB edition

First up, via our friend Joe K, a story of subsidy #Clawback and a (non?)dependent son:

"Junior did not live with Mom and Dad. Junior was on his own and working, but applied for Section 36B largesse. All this unbeknownst to Senior and Delores. Until."

So he applied for, and received, a subsidy, unbeknownst to Mom and Dad. Who then got nicked for the balance.

Oh, and the boy is a real winner:

"Junior puts in an affidavit, but never shows for the trial."

Gee, thanks, son.

Next comes this post from The Political Hat:

"Now, in Canada, a doctor can not only deny life-saving treatment for a person in their right mind who wants it, but actually have that patient, against the patient’s will and with their full mental faculties, outright executed by lethal injection"

And no, that's not hyperbole, nor is it much of  surprise. As we noted earlier this year:

"Euthanasia became legal in Canada in June and by December Quebec bioethicists had already published an article in the Journal of Medical Ethics calling for organ donation after euthanasia."

To be fair, parts is parts.

On a happier note, and in the waning days of Life Insurance Awareness Month, Allison Bell tells us that:

"Young Consumers' Life Activity Rises ... says U.S. individual life insurance application activity for consumers under age 45 increased 0.2%, year over year."

That's according to the folks at the MIB.

Good news!

Tuesday, September 26, 2017

Underwriting Annuities

Please bear with me here: although this may seem a bit "inside baseball," there's actually a larger point to be made (and we'll get to it shortly).

In brief, annuities are simply money vehicles issued by insurance carriers. They look and act a lot like CD's, with two important distinctions: first, the interest builds up on a tax-advantaged basis, and when the time comes, the money can be paid out in an income stream that you can't outlive.

Because they're essentially savings accounts (although some are designed to mimic mutual funds and the like) they're not generally underwritten; that is, the carrier doesn't really care if you run marathons or are on chemo.

But this creates an interesting problem (and the point to which I alluded): the fact that one's lifestyle plays no part puts some folks at a disadvantage.

How's that?

Well, let's say you smoke a pack or two a day. The annuitization factors (the values the carrier uses to determine the amount of that lifetime income stream) don't take that into account, but you're more likely to receive much less income than your non-smoking twin. That's because you're more likely to die sooner than he is, and thus receive much less value. Same would hold true for someone already being treated for cancer or AIDS.

Which is why I was so intrigued by this email from our friends at Issue Insurance:

"Explore the Advantages of Underwriting for Clients in Poor Health."

Apparently, Genworth is rolling out an underwritten annuity product that "can work in favor of those who are in poor health or in need of care now." It'll be interesting how that does, and if other carriers follow suit.

Kudos, Genworth!

Sunday, September 24, 2017

The Obamacare Health Insurance Fee. It's baaaaaack!

The so-called "Health Insurance Fee" levied as part of Obamacare was given a moratorium for one year, 2017, but will apply again in 2018.

This Fee increased overall premiums by around $13 billion during 2016, $0 in 2017, and is expected to increase premiums by more than $14 billion in 2018 according to consultants Oliver Wyman

That one-year moratorium on the HIF was an important factor to insurance companies.  It meant a significant cost did not have to be included in their 2017 premiums - which of course insurers had to calculate and announce well before year-end 2016. (In other words, prior to the 2016 elections.  But why be divisive and mention that?)  And for 2018, the end of the one-year moratorium means the HIF cost must again be added to premiums.

Oliver Wyman and others expect the 2018 HIF will raise overall premiums by about 3%.  That will be on top of whatever increase is attributable to the continuing increases in unit costs of medical services, plus the effect of generally higher utilization of medical services.

The exact impact of HIF on any specific policy may be more or less than 3% and depends on many factors, such as whether you are buying as an individual, or as part of a group; whether your group sponsor subsidizes your premiums and, if so, by how much; and whether your coverage will change as of January 1.

Whatever, the return of HIF helps explain why we are already reading of high medical insurance premium increases for 2018. Here is one source.  There are others.

UPDATE September 26, 2017:  FYI, the estimated 2018 per person, per month HIF will be about $35.  That is 3% of the 2017 Medicare A and B per person, per month premium of just under $1,200.  The Medicare premiums for 2018 have not yet been announced.

Friday, September 22, 2017

Medicare Open Enrollment 2018

Medicare 2018 Open Enrollment starts on October 15th and ends on December the 7th. Where can I get answers to my questions? What can I change? What can't I change? Why should I change?

Where can I get answers about Medicare Open Enrollment 2018?

Almost anywhere.

1-800-MEDICARE or is where many look for answers. Others will call a carrier. Some will talk with SHIP volunteers while others prefer an agent.

You can also ask your hair stylist, your mechanic, the person who mows your yard.

The list is endless.

The more appropriate question is, "Where can I find reliable information that is useful?".

What can I change?

Your Medicare Advantage plan, your drug plan.

What can't I change?

Your supplement plan UNLESS you answer health questions and are approved by an underwriter.

Why should I change?


If you have a Medicare Advantage plan and don't like your 2018 benefits and/or provider networks, consider other options.

If you have a stand alone drug plan, and especially if you have not changed it in several years, you are probably paying too much for your medications. For more detail on this visit Medicare Open Enrollment 2018 at Georgia Medicare Plans and scroll down to"Medicare Drug Plans Are Confusing".

Medicare supplement plans can be changed any time (subject to medical underwriting). My advice on changing supplement plans is to do it any time of the year OUTSIDE OF Medicare open enrollment.

#MedicareOpenEnrollment #MedicarePartD

Thursday, September 21, 2017

And now for something completely different...

If you're a gamer, you need to see this from the masters of terrain (and Friends of InsureBlog), Fat Dragon Games:

Kickstarter now open...

Wednesday, September 20, 2017

Who Lives, Who Dies

Talk radio host Dennis Prager enlightens me in ways others do not. While most talk radio focuses on politics or news, his show is different. It does address current issues but also offers up topics like the Male-Female Hour that discusses gender differences. Another is the Ultimate Issues Hour that plumbs the depths of human conscious.

One thing I really enjoy is the way Dennis weaves life lessons in his discussions punctuated with references to Jewish and Christian values. He is a practicing Jew and teacher who has studied many of the world religions, including Christianity. Frequent references to the Torah and Bible are interjected into his topics but his show is not a religious show. It is extremely educational and thought provoking.

Tonight is the beginning of Rosh Hashanah. I am not Jewish, nor am I an expert on their customs. For that I defer to Hank.

Jewish prayers intrigue me. The depth of emotion is captivating and insightful. One of the High Holy Day prayers is about "Who lives, who dies and who tells your story". Fascinating topic.

the creative tension centers on the question:  who drives the story of your life?  Is the story of your life fundamentally what you do, the choices you make, the path you chart, the relationships you forge, the work you do that is either meaningful to you or just a paycheck, the health you do or do not take care of,  the family ties you do or do not nurture?  Or, is life what happens to you? - Temple Emanuel 

Is there more to life than a bank account, social status or a career?

Who drives your story?  You can call it the fates, you can call it good luck or bad luck, you can call it God if that happens to be your theology, but it is clear that stuff happens, the vicissitudes of health and wealth and career, happen to you, and that has a decisive impact on your story.

I encourage you to click the link and read the Rabbi's life lesson. Notice how he mixes the story of Hamilton, the essence of the prayer and closes with sharing how Sheryl Sandberg dealt with the sudden loss of her husband.

Read, learn, explore your life story at a level that perhaps you never have before.

Navigator Funding and Agent Commissions

Obamacare supporters and Democrats in congress are outraged to learn that President Trump is cutting funding for an arm of Obamacare's outreach known as "Navigators". These unlicensed individuals who don't have professional liability insurance have been responsible for enrolling 81,426 people into Obamacare policies since 2014. They have also played a role in educating the public through various activities.

Since the rollout of, Navigators have received funding of:  $67 million for 2014, $60 million for 2015, $67 million for 2016, and $63 million for 2017. That's a cool grand total of $257,000,000. Breaking this number down it works out to a per enrolled person per month fee of $65.75.

With Trump cutting their funding to $36 million for 2018 many of these programs are being forced to reduce workforce and find alternative ways to perform outreach and enrollment. 

Meanwhile, professional health insurance agents are licensed, carry liability insurance, and annually certify to sell Obamacare policies. We also play a vital role in educating the public through various activities. In 2014 agents enrolled over 500,000 people in California alone.

Unlike navigators, insurance agents can ask people specific questions about their health, budget, and then recommend a specific plan or insurer. There are so many variables for consumers to review before making an informed decision. That's why agents have a discussion on provider networks, deductibles, copays, drug costs and other insurance provisions long before talking about premiums.

Since the rollout of agents have seen our commissions cut - and in some cases - eliminated. Even when we are paid it's not even close to what navigators have received. According to the Kaiser Family Foundation back in 2013 the average commission agents received on a per person per month basis was $12.24.

There was no outrage when our "funding" was cut. There was no media coverage showing support for licensed professionals.

Yet many of us persevere. We do so because we know how vital we are to the clients we serve. We do so because we know the value of the product we sell and the service we provide. We are the conduit between insurance companies, providers, and our client.

There are so many things that Navigators can't do. But professional insurance agents, we do it - and at a fraction of the cost.

Tuesday, September 19, 2017

Yeah, about that promise

You may recall it:


First, in email from Anthem:

"Small Group plans will not be offered on SHOP in 2018

Anthem will no longer offer Small Group plans on the federally-facilitated SHOP (Small Business Health Options Program) Marketplace in Ohio for 2018

To be fair, it's not like the SHOP program's been such a rousing success.

Of far greater import, however, is this:

"63 Counties Projected to Have No Obamacare Insurer in 2018"

And almost 1,500 are down to one insurer (so much for choice. Or competition). This is actually more significant than one might think: back in June, there were only 47 counties projected to have no carrier choices for '18; this represents a 30+ percent increase in just a few months.

And no end in sight.

[Hat Tip: Ace of Spades]

Monday, September 18, 2017

More ObamaPlan Anecdata

So, two (more) examples:

■ Email from Betty:

"Don't know if you'll remember me, but in April/May 2016 you had helped me evaluate health insurance for me with my husband retiring.  It ended up that going through his COBRA was the best option for me at the time.  Well, I'm now coming to the close of that (have coverage through Jan. 2018), but I know sign up for the ACA is Nov. 1. - Dec. 15 so I need to start the process again.  Are you still available to help me?"

In reply, I told her about my decision to hand these off to trusted partner Cornerstone.

She responded:

"I'm sorry, but I really don't understand your response.  This sounds different from they way things were when we sat down and talked before.  At that time you had looked into different insurance companies to see what they offered, etc.  Now are you saying you know of someone else who would do this for me?  You had helped me search out options instead of me going on the ACA website myself."

So I sent her the link to my post last year on why I've decided to sit out (for the most part) Open Enrollment.

I wasn't terribly surprised to receive this:

"Per your blog, I would like to talk to the folks at Cornerstone.  Please forward my info to them for referral.  Thanks!"

And of course I will.

■ A few days later, Sheila called me about her health insurance needs. She immediately launched into a request for a detailed description of the various companies we represent, as well as plan options and costs.

I cut her off as quickly as I could, telling her "no, I can't do that."

There was a moment of stunned silence, and she asked "Why not? I work at a schoold and they've always provided that to me." I explained that they're a rather large organization that can afford to do that, and that I no longer sell plans in between Open Enrollment (she and her children seem to qualify for a Special Open Enrollment).

She immediately understood, and asked if  could refer her to another agent. I told her that I don't know of any other local agents still selling health insurance outside of Open Enrollment. She took that in, and then asked "well, what can I do?"

I didn't want to leave this poor lady just twisting in the wind, so I directed her to the site, and gave her some pointers about navigating it (SWIDT?).

Thus life under ObamaCare.

Friday, September 15, 2017

LifeLock: Color me underwhelmed

So, the Equifax risk-checking tool confirmed that I was likely part of that elite group of 143 million Americans whose info was hacked. I'd been looking for an excuse to pull the trigger on LifeLock, so popped over (using the special IB link that generates an automagic 10% discount).

There was a welcome ("splash") screen, and at the top of the page I clicked "Enroll Now" (I already knew which plan I wanted). The process was pretty straightforward: you put in your name and address and so on, then the info for dependents (if any). One of the key requirements is an active email address, which I happily provided.

At the end, it asked about which credit card I wanted to use, warning me that it would be charged immediately.

Okay, whatever, let's get this thing done.

I finished up, hit "Complete" and ... that was the last I've ever heard from them.

No confirmation email. No notification that our application was being processed. No Welcome to LifeLock. Nada. Zip. Zilch.

I had just agreed to spend several hundred dollars with them, and they couldn't even be bothered to say "okay, got your info, stand by."

The only way I knew we'd been approved (and thus effective) was checking into the site every few hours. A full day later I saw that the plan would become effective October 1 (which, by the by, would have been nice if that'd been more conspicuously disclosed upfront).

By way of contrast, I recently ordered a $3.67 item from Walmart. I immediately received a confirmation email, then a follow-up when it shipped, and then notification when it arrived.

That's how it's done.

I realize that - so far - LifeLock has no credible competitors, but eventually they will, and I will bail on them in a heartbeat.

By the way, this doesn't exactly engender a great deal of confidence about how I'm going to be treated now that they have my money.

ADDENDUM: So, a very nice lady from LifeLock (finally) returned my call, asking how she could be of assistance. I thanked her, and then explained that that ship had sailed, and expressed (as nicely as I could) why and where they had failed.

She tried to explain the lack of communication, and I immediately shut her down: there is no excuse for such deplorable customer "service."

Here's a clue: If you have to explain why your customer service experience is so poor, #You'reDoingItWrong.

Thursday, September 14, 2017

Happy Fun Time Insurance

The other day, we discussed what we've been calling "Special Event" insurance. And that's an accurate designation, up to a point. That type of plan falls under the category of "indemnification" (being made whole).

But there's another type of Special Events coverage, one that covers liability.


Here's an example:

A good friend of mine hosted his daughter's wedding reception at a local luxury car museum. He knew that there would be alcohol, as well as little children running around. And he knew that there were millions of dollars’ worth of antique luxury cars protected by, at most, a velvet rope.

So he (wisely) purchased this second kind of Special Events cover.



"Markel’s special event cancellation and event liability insurance protects event hosts and honorees from losses they may face, should the unfortunate occur. Policies start as low as $75"

(I'm going to focus on the liability aspect of this plan, because I think the cancellation part falls into the indemnification/"baseball insurance" camp)

Think about all the different kinds of events to which this would apply: weddings, of course, but Bar/Bat Mitzvah celebrations, auctions, and offsite business meetings, for starters.

And especially if these involve serving alcohol:

"Host liquor liability included."

And as the brochure points out "[m]any venues require liability insurance." I have to admit, I hadn't even thought of that. But it makes sense, no?

Oh, one last thing, which now seems obvious:

"Policies ... can be purchased any time at least one day before the event date" [emphasis added]

No kidding.

Special IB Thanks to Bill M for suggesting this topic and helping put together this post.

Legislation Summer Health Wonk Review

Our friend Louise Norris hosts this week's eclectic collection of health care punditry. As usual, she provides excellent context with each link.

Kudos, Louise!

Wednesday, September 13, 2017

About that "bending the cost curve down" promise

Turns out, as with pretty much everything ObamaCare, its proponents - get this - lied to us about the cost of meds

"Out-of-pocket costs for specialty drugs under the Affordable Care Act increased 16 percent from 2016 to 2017."

As folks have been learning for some time now, just because plans are required to cover prescriptions, they aren't required to cover all of them. Here's why:

"For a plan to help pay for a drug, the drug must first be included on the health plan's formulary."

We noted this almost a dozen years ago:

"Health insurance is competitive. Most consider it a commodity and compare based on price alone.

Drug formularies are just one way to accomplish this."

La plus ca change...

And since these med's aren't covered, buying them on one's own nickel means that their purchase doesn't count towards the plan's out-of-pocket.

But hey, free birth control convenience items.

[Hat Tip: FoIB Jeff M]

Tuesday, September 12, 2017

Home Run Insurance

Over the years, we've talked about Marathon insurance, Football insurance, even Snow insurance. But this is a new one: Baseball insurance.

"Earlier this season, local window company Universal Windows Direct offered an intriguing promotion: any purchases made in the month of July would be refunded in full if the Indians notched a 15-game winning streak before the end of the season."

Well, they've already surpassed that, which is bad news for the window folks.

Or is it?

As you've probably guessed, there is no such thing as Marathon or Snow insurance, let alone Baseball. But the folks who run the company had purchased "Special Event" coverage, which cost "$75,000 ... to cover the $1.7 million," truly a bargain.

As we noted back in Aught Nine:

"Special Event insurance is just that: coverage to protect one from a sudden loss during some unusual activity or promotion. Think "$1 million Hole In One Contest."

And Bob's your uncle.

Monday, September 11, 2017

The MVNHS© Bites

Or, perhaps more accurately, gums. The British, never really known for their dental hygiene, seem to have reached a milestone:

"A couple in need of dental care say they had to pull out their own teeth because no NHS dentist will treat them."

This, by the way, is why Medicaid doesn't actually work, and why the newest crop of ObamaPlans are subpar as well: what good is health (or dental) insurance if you can't use it?

In the case of the Much Vaunted National Health System© vs molars, et al, there just aren't enough dentists to go around, and the ones still in practice aren't taking on new patients. This kind of self-dentistry, though, definitely seems over-the-top.

Still, what alternative did they have?

Oh, and Brits receive medical care for "free" but have what is essentially a co-pay for dental care visits. In England, that can run about $27.

And there's this:

"The vast majority of dentists are self-employed so the government doesn't pay our staff or our overheads like a hospital."

Imagine that...